Summary: Dr Al Dowie reflects on the relationship between old and new in evidence-based ethics education.

Description: Does our ethics teaching make a difference to the professional practice of tomorrow’s doctors? It seems a reasonable question. If we could design a randomised controlled trial in which the experimental group of students receives formal ethics instruction and the control group experiences no such educational intervention, would there be statistically significant differences in outcome or not? Either way, how could we tell? What would the outcome measures be? If an assessment, would it be written or practical? And would a test validly and reliably tell us anything about learners’ ethics? In any case, might the trial be confounded by some other exposure for which there is no control, such as the example of role models, positive or otherwise?

A few moments reflection, then, and our ostensibly simple question begets a host of complexities. Nor is its difficulty confined to medicine. All the business ethics courses in all the MBA programmes undertaken by all the managers in the banking sector were inconsequential to the practices that precipitated the global financial catastrophe that struck in September 2008. But perhaps the comparison is not an appropriate one; looking after patients is not the same as looking after other people’s capital.

Might the estate of journalism offer an alternative benchmark? The Leveson Inquiry into the culture, practices and ethics of the press in the UK noted a parallel failure in media ethics courses:

Members of the organisation can undergo ‘ethics training’ but it will have little effect. As soon as they return from the training to their desk or office, the pervasive culture will dominate their decision-making. The culture brings to bear all sorts of ‘accepted norms’ which an afternoon’s training will be relatively powerless to affect.1

Nevertheless, the call for increased provision of ethics training continues to be a typical response to crises of public confidence in any sector.

What this tells us is no more than what has been known since antiquity, which is that a purely cognitive acquisition of ethical ideas is not the foundation for an ethical sensibility or for ethical practice. Aristotle observed that theoretical understanding “never contemplates what is done in action, and says nothing about what is to be avoided or pursued.” 2

One of the limitations of ethics education in general is that it is either not at all practical or not sufficiently so, which is to say it is over-reliant on theory. Nor is it a matter of shifting the balance towards the application of theory, as if we begin by formulating first principles and then subsequently apply these to practical contexts. The 19th century ethicist John Stuart Mill considered this to be a misrepresentation that is “palmed upon us”. He continues:

What are called first principles are, in truth, last principles... Though presented as if all other truths were to be deduced from them, they are the truths which are last arrived at; the result of the last stage of generalization, or of the last and subtlest process of analysis.3

Our task as educators is of course to innovate approaches to ethics learning that are of our own era and fit for purpose according to the requirements of the day. But it is also to keep sight of essential insights that come to us from time past; what TS Eliot expressed as “the fight to recover what has been lost and found and lost again and again.” 4

References

1) The Right Honourable Lord Justice Leveson. (2012) An Inquiry into the Culture, Practices and Ethics of the Press: Report. London: The Stationery Office Limited, Volume 1, p.86. Online: http://www.official-documents.gov.uk/document/hc1213/hc07/0780/0780_i.pdf. Accessed: 25 February 2015.
2) Reeve CDC. (2012) Action, Contemplation, and Happiness: An Essay on Aristotle. London: Harvard University Press, p.56.
3) Mill JS. (1967) On the Definition of Political Economy; and on the Method of Investigation Proper To It. In: Essays on Economics and Society, vol. IV of Collected Works of John Stuart Mill, ed. John M. Robson. London: Routledge & Kegan Paul, p.311.
4) Eliot TS. (2001) East Coker, V. In: Four Quartets. London: Faber & Faber.